临床医药实践
臨床醫藥實踐
림상의약실천
PROCEEDING OF CLINICAL MEDICINE
2015年
8期
589-591,592
,共4页
妊娠%急性胰腺炎%诊断%治疗
妊娠%急性胰腺炎%診斷%治療
임신%급성이선염%진단%치료
pregnancy%acute pancreatitis%diagnoses%treatment
目的：探讨妊娠合并急性胰腺炎（APIP）的病因、临床特点、早期诊断及合理治疗策略。方法：回顾性分析2011年3月—2014年3月住院治疗的15例妊娠合并急性胰腺炎患者的临床资料。结果：11例轻型 APIP 均给予保守治疗，无一例因胰腺炎行手术终止妊娠，母婴均健康出院；4例重型 APIP 中1例孕15周，行药物引产+内镜逆行胰胆管造影（ERCP）乳头切开清除胆管结石+鼻胆管引流；1例孕32周，病情发展迅速，紧急行剖宫产终止妊娠，新生儿无窒息；1例孕34周经产妇，死胎合并多脏器功能损害，经阴道娩出；1例孕38周，因胎儿窘迫急诊行剖宫，术中同时行胰周引流，新生儿重度窒息转新生儿治疗，孕妇均治愈。结论：APIP 发病率低，多发生于妊娠的晚期，胆道疾患与高脂血症是主要病因，动态检测血尿淀粉酶变化，及时行 B 超或 CT 检查对早诊断有重要价值。妊娠合并轻型 APIP 不是终止妊娠的指证，保守治疗效果好；妊娠合并重型 APIP 应个体化治疗，优先保证孕母安全，及时终止妊娠，终止方法首选剖宫产，术中可同时做相应的外科治疗。
目的：探討妊娠閤併急性胰腺炎（APIP）的病因、臨床特點、早期診斷及閤理治療策略。方法：迴顧性分析2011年3月—2014年3月住院治療的15例妊娠閤併急性胰腺炎患者的臨床資料。結果：11例輕型 APIP 均給予保守治療，無一例因胰腺炎行手術終止妊娠，母嬰均健康齣院；4例重型 APIP 中1例孕15週，行藥物引產+內鏡逆行胰膽管造影（ERCP）乳頭切開清除膽管結石+鼻膽管引流；1例孕32週，病情髮展迅速，緊急行剖宮產終止妊娠，新生兒無窒息；1例孕34週經產婦，死胎閤併多髒器功能損害，經陰道娩齣；1例孕38週，因胎兒窘迫急診行剖宮，術中同時行胰週引流，新生兒重度窒息轉新生兒治療，孕婦均治愈。結論：APIP 髮病率低，多髮生于妊娠的晚期，膽道疾患與高脂血癥是主要病因，動態檢測血尿澱粉酶變化，及時行 B 超或 CT 檢查對早診斷有重要價值。妊娠閤併輕型 APIP 不是終止妊娠的指證，保守治療效果好；妊娠閤併重型 APIP 應箇體化治療，優先保證孕母安全，及時終止妊娠，終止方法首選剖宮產，術中可同時做相應的外科治療。
목적：탐토임신합병급성이선염（APIP）적병인、림상특점、조기진단급합리치료책략。방법：회고성분석2011년3월—2014년3월주원치료적15례임신합병급성이선염환자적림상자료。결과：11례경형 APIP 균급여보수치료，무일례인이선염행수술종지임신，모영균건강출원；4례중형 APIP 중1례잉15주，행약물인산+내경역행이담관조영（ERCP）유두절개청제담관결석+비담관인류；1례잉32주，병정발전신속，긴급행부궁산종지임신，신생인무질식；1례잉34주경산부，사태합병다장기공능손해，경음도면출；1례잉38주，인태인군박급진행부궁，술중동시행이주인류，신생인중도질식전신생인치료，잉부균치유。결론：APIP 발병솔저，다발생우임신적만기，담도질환여고지혈증시주요병인，동태검측혈뇨정분매변화，급시행 B 초혹 CT 검사대조진단유중요개치。임신합병경형 APIP 불시종지임신적지증，보수치료효과호；임신합병중형 APIP 응개체화치료，우선보증잉모안전，급시종지임신，종지방법수선부궁산，술중가동시주상응적외과치료。
Objective:To investigate the pathogenesis,early diagnosis and treatment of pregnancy complicating acute pan-creatitis(APIP). Methods:Retrospective analysis the 15 cases′ clinical data of pregnancy complicating acute pancreatitis from March 2011 to March 2014 in First people′s Hospital of Yancheng. Results:Eleven cases of mild patients adopted the conserva-tive treatment,no one case proceeded the cesarean section as the pancreatitis,infant and mom all discharge from hospital healthly. In the 4 cases of severe patients,1 case had pregnant for 15 weeks,and proceeded the drug induced labor + endo-scopic retrograde cholangio pancreatography( ERCP)nipple incision to remove bile duct calculi + endoscopic nasobiliary drainage. 1 case of pregnant for 32 weeks,the illness has been developing rapidly,emergency cesarean delivery termination,no newborn babies;1 case pregnant for 34 weeks,stillbirth combined multiple organ function damage,transvaginal childbirth;1 case of pregnant for 38 weeks,emergency cesarean delivery as the fetal distress,intraoperative peripancreatic drainage at the same time,neonatal severe neonatal asphyxia conservative therapy,and the pregnant women were all cured. Conclusion:The in-cidence of pregnancy complicating acute pancreatitis is low,mainly happened in late pregnancy,gallbladder disease and hyper-lipidemia is the main cause,dynamic observation of blood urine amylase and ultrasound or CT examination has important value in early diagnosis. Pregnant complicating mild pancreatitis not the indications of cesarean delivery,the conservative treatment effect is good. Pregnancy complicating severe pancreatitis should get individualized treatment,priority to ensure the safety of pregnant women,cesarean delivery in time,pregnancy termination methods prefer cesarean delivery,intraoperative correspond-ing surgical treatment should be considered.
